Vaginal prolapse is the loss of support to the pelvic organs that surround the vagina. This results in the bulging (dropping) of the bladder, urethra, rectum or uterus into the vagina. It may also be associated with urinary incontinence (leaking of urine on cough or any other stressful movement) or fecal incontinence (leaking of stools).
Prolapse can involve any of the walls and/or the top of the vagina. The types include:
Prolapse of the anterior compartment: This is the most common type and involves the herniation of the bladder and/or the urethra into the vagina. This is called as a cystocele or a cysto-urethrocele.
Prolapse of the posterior compartment: This involves the herniation of the rectum into the back wall of the vagina (called as a rectocele). You can read more about rectocele here. Rectocele may/may not be associated with the herniation of part of the small bowel into the upper part of the back wall of the vagina (called as an enterocele). You can read more about enterocele here.
Prolapse of the apical compartment or the top of the vagina:This is of two types:
Uterine prolapse: This occurs when the uterus herniates into the vagina. This is the second most common type of prolapse.
Vaginal vault prolapse:This occurs following hysterectomy. The top of the vagina may lose its support and invert into the vagina like a stocking everted inside out.
The severity of prolapse can vary from a slight herniation to a bulge that comes out of the vagina.
Prolapse is likely to affect about one in three women who have had children. However prolapse varies in severity and only one in 9 women (11%) will need to undergo surgery for the problem.
The pelvic organs are supported in their normal position by the muscles and ligaments of the pelvis that work in a coordinated manner under the control of nerves from the spinal cord to withstand any rise in the intra-abdominal pressure. Damage to this support system results in prolapse. Damage can result from
Pregnancy and childbirth: These are the most common causes of prolapse, especially vaginal delivery. The severity of the damage is more in patients who have undergone forceps delivery or an episiotomy. The prolapse can manifest shortly after the pregnancy or many years later.
Aging and the hormonal changes resulting from menopause cause further weakening of the pelvic floor structures.
Conditions that increase the intra-abdominal pressure and cause excessive pressure on the pelvic floor, such as obesity, chronic cough, chronic constipation, heavy lifting and straining.
Genetic factors can also play a role: some women have increased risk for prolapse due to their genetic inheritance. Some connective tissue disorders like Marfan’s syndrome and Ehlers-Danlos syndrome can also be associated with weak soft tissue leading to prolapse, but these conditions are rare.
Many patients are asymptomatic. The symptoms include
Please visit our patient information center here to read about these individual conditions.
In the prolapse clinic at UPHI, we aim to provide the best in care for the treatment of prolapse. We will work with you to create a treatment plan most suited to your individual characteristics: your support defects, age, needs, physical condition, and activity.
Your doctor will perform a thorough physical examination including the vaginal examination to understand the extent and cause of the problem and the specific support defect.
Another specialized testing may be necessary if you have concomitant urinary incontinence, fecal incontinence or constipation and also to test if your bladder is infected or emptying properly.
There are a variety of non-surgical and surgical treatments available for prolapse.
Physiotherapy : For patients with mild prolapse, exercises to strengthen the muscles and ligaments may help in supporting the pelvic organs and prevent progression. Pelvic exercises may also help prevent recurrent prolapse after surgical repair and correct any uncoordinated movement of the pelvic floor that may be worsening the prolapse or may be responsible for failure following surgery.
Treatment and avoidance of constipation by adding high fiber foods and natural stool softeners. Constipation can worsen the prolapse.
Application of low-dose estrogen cream vaginally may help in the case of thinning of vaginal wall and dryness and help improve vaginal support.
Pessaries: Pessaries are devices placed in the vagina to support the vaginal wall. Different types of pessaries are available. The design and size most appropriate for you will be fitted in our office and you will be taught how to remove it for cleaning and replacing it yourself.
When the prolapse is left untreated, it can get increasingly worse, and may eventually require surgical intervention.
Our goal is to identify and address surgically all sites of weakness in the vaginal wall, thereby minimizing the risk of recurrence. These state-of-the-art operative repairs are often combined with repairs for urinary incontinence and fecal incontinence.
Though almost all surgical repairs are performed through the vaginal route, a laparoscopic repair will be performed for select cases, for example, recurrent prolapse after vaginal hysterectomy.
If you believe you may be experiencing prolapse of any of the pelvic organs, the prolapse clinic at UPHI can help you. Our multidisciplinary approach combines the best in non-surgical and surgical treatments provided by internationally trained doctors and a comprehensive physiotherapy team under one roof.
Often patients with prolapse have concomitant bowel and bladder problems, especially urinary incontinence. Our Integrated Pelvic Floor Centre ensures that we provide you with all the solutions that you need for your pelvic floor problems.
Our physicians and healthcare professionals offer the best, most compassionate care for women in a state-of-the-art facility to ensure that you receive the most effective and technologically advanced treatments.
Contact UPHI today to schedule a consultation & appointment with one of our specialists.
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